Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future

BMC Med. 2011 Sep 22;9:107. doi: 10.1186/1741-7015-9-107.

Abstract

There are a number of limitations to using conventional diagnostic markers for patients with clinical suspicion of infection. As a consequence, unnecessary and prolonged exposure to antimicrobial agents adversely affect patient outcomes, while inappropriate antibiotic therapy increases antibiotic resistance. A growing body of evidence supports the use of procalcitonin (PCT) to improve diagnosis of bacterial infections and to guide antibiotic therapy. For patients with upper and lower respiratory tract infection, post-operative infections and for severe sepsis patients in the intensive care unit, randomized-controlled trials have shown a benefit of using PCT algorithms to guide decisions about initiation and/or discontinuation of antibiotic therapy. For some other types of infections, observational studies have shown promising first results, but further intervention studies are needed before use of PCT in clinical routine can be recommended. The aim of this review is to summarize the current evidence for PCT in different infections and clinical settings, and discuss the reliability of this marker when used with validated diagnostic algorithms.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Bacterial Infections / diagnosis*
  • Bacterial Infections / drug therapy*
  • Calcitonin / blood*
  • Calcitonin Gene-Related Peptide
  • Clinical Laboratory Techniques / methods*
  • Drug Monitoring / methods*
  • Humans
  • Protein Precursors / blood*
  • Randomized Controlled Trials as Topic
  • Respiratory Tract Infections / diagnosis
  • Respiratory Tract Infections / drug therapy
  • Sepsis / diagnosis
  • Sepsis / drug therapy
  • Surgical Wound Infection / diagnosis
  • Surgical Wound Infection / drug therapy
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • CALCA protein, human
  • Protein Precursors
  • Calcitonin
  • Calcitonin Gene-Related Peptide